SAN FRANCISCO: End of life care is still dominated by clinicians, pain relief, hospitals, skilled nursing homes and sterile settings, despite a growing demand for a deeply personalized exit.
The skilled nursing home sector is in danger of losing a large portion of the ‘end of life’ market as it fails to adapt to new expectations and methodologies.
The culture and rigidity of skilled nursing home dictates precludes involvement, as skilled nursing homes seem unable or unwilling to shuck the narrow clinical approach.
Skilled nursing homes have failed to recognize that people have priorities that they need us to serve besides just living longer. Second, the best way to learn those priorities is to ask about them. Hence the wide expert agreement that payment systems should enable health professionals to take sufficient time to have such discussions and tune care accordingly.
The discussions most successful clinicians had with patients involved just a few important questions that often unlocked transformative possibilities: (1) What is their understanding of their health or condition? (2) What are their goals if their health worsens? (3) What are their fears? And (4) What are the trade-offs they are willing to make and not willing to make? These discussions must be repeated over time, because people’s answers change. But people can and should insist that others know and respect their priorities.
Skilled nursing homes have forgotten the vital human needs as people approach life’s end. People want to share memories, pass on wisdoms and keepsakes, connect with loved ones and to make some last contributions to the world. These moments are among life’s most important, for both the dying and those left behind. And the way we in medicine deny people these moments, out of obtuseness and neglect, should be cause for our unending shame.